Most benefit plans have fees that you need to pay depending on the care you receive. These payments are called “out-of-pocket expenses.” They fall into the following categories –
- Copayments (or Copays) – A fixed amount you pay for a health care service, usually at the time you get the service. The amount can vary by the type of covered health care service
- Coinsurance – The amount you pay for a health care service. It is usually a percent. For example, if your plan pays $100 for an office visit, a coinsurance payment of 20% would be $20
- Deductible – The amount you must pay for health services before your health plan begins to pay. For example, if your deductible is $500, your health plan won’t pay anything until you’ve paid $500. The deductible may not apply to all services
- Usual, Customary and Reasonable Charge (UCR) – The amount your health plan will pay for a medical service. This is based on what other providers in the area usually charge for the same kind of service. You may be responsible for paying charges that are above the UCR and other out-of-pocket costs
Estimate Your Out-of-Pocket Costs
Determine costs you may incur prior to receiving health care services using the Determination of Benefits Form. To complete the form, you will have to ask your provider for certain medical coding information including procedure codes, procedure modifiers and unit codes for the services.
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